Rectal cancer staging using MRI: adherence in reporting to evidence-based practice.

Nina Sellberg,Gustav Alvfeldt,Peter Aspelin,Lennart Blomqvist

doi:10.1177/0284185120906663

Abstract

BackgroundMagnetic resonance imaging (MRI) is the first-line imaging modality for local staging of rectal cancer. The radiology report should deliver all relevant available imaging information to guide treatment.PurposeTo explore and describe if there was a gap between the contents in MRI reports for primary staging of rectal cancer in Sweden in 2010 compared to evidence-based practice.Material and MethodsA total of 243 primary MRI staging reports from 2010, collected from 10 hospitals in four healthcare regions in Sweden, were analyzed using content analysis with a deductive thematic coding scheme based on evidence-based practice. Focus was on: (i) most frequently reported findings; (ii) correlation to key prognostic findings; and (iii) identifying if any findings being reported were beyond the information defined in evidence-based practice.ResultsMost frequently reported findings were spread through the bowel wall or not, local lymph node description, tumor length, and distance of tumor from anal verge. These items accounted for 35% of the reporting content. Of all reported content, 86% correlated with the evidence-based practice. However, these included more information than was generally found in the reports. When adjusting for omitted information, 48% of the reported content were accounted for. Of the reported content, 20% correlated to key pathological prognostic findings. Six types of findings were reported beyond the evidence-based practice, representing 14% of the total reporting content.ConclusionThere was a gap between everyday practice and evidence-based practice in 2010. This indicates a need for national harmonization and implementation of standardized structured reporting templates.

Highlights

Colorectal cancer is the third most common form of cancer in Sweden, affecting around 6200 people
The focus was on adherence to the evidence-based practice (EBP) and: (i) what findings were being frequently most reported; (ii) to what extent the reports correlated to key pathological prognostic findings as described by the MERCURY study; and (iii) if there were clinical concepts and findings frequently reported beyond the scope of the EBP
Other studies have used forms of content analysis to analyze the content in electronical medical records, e.g. to compare notes to content in EMR templates [32] and to analyze free-text content of radiology reports in comparison to RSNA reporting templates [33]

Summary

Introduction

Colorectal cancer is the third most common form of cancer in Sweden, affecting around 6200 people. The results of the MERCURY study group, published during the mid-2000s [1,3,6] and describing the interpretation of images and acquisition techniques for MRI examinations of rectal cancer patients with particular focus on key pathological prognostic factors of importance, was followed by a number of publications in the field [4,7,8,9,10] This has contributed to a more standardized and systematic approach to staging, reading, and reporting of rectal cancer as well as clinical recommendations and practice guidelines [5,11]. This indicates a need for national harmonization and implementation of standardized structured reporting templates

Methods

Results

Conclusion